Medicare Denying Block Payment

[Sevo]

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Recently received the following from the Arizona state society. Obviously, this affects Arizona and states that rely on Nordian to manage Medicare reimbursement, but it's crystal clear that Medicare is looking to start denying payment for blocks as a means to curb costs across the board.

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Dear Arizona Society of Anesthesiologists member,

Please be aware that there is an issue in Arizona which needs your urgent attention and prompt written response. Arizona's Medicare contractor, Noridian, is attempting to make a payment change which will significantly affect your practice. A nerve block Local Coverage Determination (LCD) is being proposed which would cease to pay for any nerve block done before a patient's discharge from the PACU, other than payment for the primary anesthetic ( see attachment).

http://library.constantcontact.com/...omatic_Selective_Nerve_Root_and_Epidural_.pdf

The written comment period is until July 11, 2013, but discussion will take place at the next CAC (Contractor Advisory Committee) meeting on June 4, 2013. Appeals must be made in writing. They should be addressed to:

Noridian Administrative Services LLC Contractor Medical Director
Policy Development - Medicare Part B - Drafts
900 42nd Street S.
Fargo, ND 58108
[email protected]

and

Gary Oakes, MD
Noridian
900 42nd Street S.
PO Box 6740
Fargo, ND 58108-6740
[email protected]

These letters should contain published clinical references, as well as explanations as to why some procedures (ie. open rotator cuffs) which are now ASC outpatient procedures will no longer be so under this proposal. Please see Anesthesiology, 2005; 102(5):1001-7 "For outpatient rotator cuff surgery, nerve block anesthesia provides superior same-day recovery over general anesthesia", and Anesthesiology, 2013: 118(5):1046-1054 "Perioperative comparative effectiveness of anesthetic technique in orthopedic patients". These are just suggestions, since obviously the more articles the better. Please make it clear that this policy will decrease patient satisfaction, and in the end increase costs.

We will be contacting the ASA on this matter as well. Please respond to Noridian ASAP. If you have any questions contact Jeff Mueller at [email protected] or myself at [email protected]. Thanks for your time and effort on this matter.

Stuart Bass MD
President, Arizona Society of Anesthesiologists

 

[IlDestriero]

These people are F'ing ******ed. Who is going to do an invasive procedure and incur risk without any compensation at all.
F that shiite.
You want to cut corners to pinch pennies, you got it.
They can get PCAs and spend a night or two for pain management. Great cost savings. If the patients don't like it, oh well, write your state rep.
Got hospital acquired infection, so sorry. I wanted to do a catheter and send you home.

 

[excalibur]

I think Blade posted on this upcoming nonsense a couple months ago.

Procedure preop to prevent pain and improve pt satisfaction--no payment.

Same procedure 30 minutes after surgery when pt is in terrible pain and has been groaning continuously and is out of recovery--thank you for your service $$$

Think I joked that I thought pt's shouldn't leave PACU if pain is not controlled anyway.

The new wave will be to DC pt from PACU to block room, and do block there. Nonsense.

 

[Tuohy]

I think Blade posted on this upcoming nonsense a couple months ago.

Procedure preop to prevent pain and improve pt satisfaction--no payment.

Same procedure 30 minutes after surgery when pt is in terrible pain and has been groaning continuously and is out of recovery--thank you for your service $$$

Think I joked that I thought pt's shouldn't leave PACU if pain is not controlled anyway.

The new wave will be to DC pt from PACU to block room, and do block there. Nonsense.

If this is the new world of anesthesia in certain states, we better stock up on antiemetics and narcan...

 

[Consigliere]

Whatevs. Just do the block post-op if that's the game they want to play.

 

[deleted126335]

These people are F'ing ******ed. Who is going to do an invasive procedure and incur risk without any compensation at all.
F that shiite.
You want to cut corners to pinch pennies, you got it.
They can get PCAs and spend a night or two for pain management. Great cost savings. If the patients don't like it, oh well, write your state rep.
Got hospital acquired infection, so sorry. I wanted to do a catheter and send you home.

uhm, what happens when the orthopods object when you stop doing blocks? What happens when administration notices that patient satisfaction scores start going down? Blocks are rapidly approaching an expected level of care. Kind of like 24/7 labor epidurals. Not this year, Not next, but in the not too distant future.

 

[Oggg]

Also the Original post says they won't pay for any nerve blocks done before discharge from PACU. So that would mean no reimbursement for postop blocks in the pacu.

 

[hrmm]

Also the Original post says they won't pay for any nerve blocks done before discharge from PACU. So that would mean no reimbursement for postop blocks in the pacu.

Right. From what I understand, just doing the block postop wouldn't be a good work-around for the change. Any postop block would likely need to be monitored somewhere.. if not PACU, then where.. inpatient? Does going from PACU --> block room count as a "discharge from the PACU?" Admitting to inpatient just for block monitoring would never fly.

This change is encouraging poor standard of care.